Peritonitis

Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.

Left untreated, peritonitis can rapidly spread into the blood (sepsis) and to other organs, resulting in multiple organ failure and death. So if you develop any of the symptoms of peritonitis -- the most common of which is severe abdominal pain -- it's essential to seek prompt medical evaluation and treatment that can prevent potentially fatal complications.

Symptoms of Peritonitis

The first symptoms of peritonitis are typically poor appetite and nausea and a dull abdominal ache that quickly turns into persistent, severe abdominal pain, which is worsened by any movement.

Other signs and symptoms related to peritonitis may include:

• Abdominal tenderness or distention
• Chills
• Fever
• Fluid in the abdomen
• Not passing any urine, or passing significantly less urine than usual
• Difficulty passing gas or having a bowel movement
• Vomiting

Causes of Peritonitis

The two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. Both types of peritonitis are life- threatening. The death rate from peritonitis depends on many factors, but can be as high as 40% in those who also have cirrhosis. As many as 10% may die from secondary peritonitis.

The most common risk factors for primary spontaneous peritonitis include:

Liver disease with cirrhosis. Such disease often causes a buildup of abdominal fluid (ascites) that can become infected.

Kidney failure getting peritoneal dialysis. This technique, which involves the implantation of a catheter into the peritoneum, is used to remove waste products in the blood of people with kidney failure. It's linked to a higher risk of peritonitis due to accidental contamination of the peritoneum by way of the catheter.

Common causes of secondary peritonitis include:

• A ruptured appendix, diverticulum, or stomach ulcer
• Digestive diseases such as Crohn's disease and diverticulitis
• Pancreatitis
• Pelvic inflammatory disease
• Perforations of the bowel, stomach, intestine, gallbladder, or appendix
• Surgery
• Trauma to the abdomen, such as an injury from a knife or gunshot wound

Noninfectious causes of peritonitis include irritants such as bile, blood, or foreign substances in the abdomen, such as barium.

Diagnosis of Peritonitis

If you have any symptoms of peritonitis, call your doctor right away. Seeking prompt medical attention is especially important for peritoneal dialysis patients who have a combination of abdominal pain and a clouding of the peritoneal fluid, which is caused by a buildup of infection-fighting white blood cells.

Because peritonitis can rapidly lead to potentially fatal complications such as sepsis and septic shock, which causes a massive drop in blood pressure, organ failure, and death, it’s essential to receive a quick diagnosis followed by appropriate treatment.

Your doctor will ask about your symptoms and medical history, and conduct a thorough physical examination, including assessment of tension and tenderness in the abdomen.

Diagnostic tests for peritonitis may include:

• Blood and urine tests
• Imaging studies such as X-rays and computerized tomography (CT) scans
• Exploratory surgery

Your doctor also may perform a paracentesis, a procedure in which fluid from the abdominal cavity is withdrawn through a thin needle and checked for infection. Paracentesis is useful for identifying primary spontaneous peritonitis and secondary peritonitis caused by pancreatitis.

Treatments for Peritonitis

If you're diagnosed with peritonitis, you'll be admitted to a hospital. Typically, you'll immediately start receiving intravenous antibiotics or antifungal medications to treat the infection. Additional supportive treatments will be necessary if organ failure from sepsis develops as a complication of the infection. Such treatments may include intravenous fluids, drugs to maintain blood pressure, and nutritional support.

If you have peritoneal dialysis-associated peritonitis, you may receive medications that are injected directly into the peritoneal space, a strategy that some studies have reported to be more effective than intravenous medications.

In many cases, emergency surgery is required, especially if peritonitis has been caused by conditions such as appendicitis, a perforated stomach ulcer, or diverticulitis. Infected tissue such as a burst appendix or abscess will be surgically removed. So will any part of the peritoneal tissue that has been seriously damaged by infection.

During your hospitalization, you will be closely monitored for signs of sepsis and septic shock, which usually require immediate transfer to an intensive care unit.

Preventing Peritonitis

For select people with cirrhosis and ascites, the doctor may prescribe antibiotics to prevent peritonitis.

Although peritonitis can be a complication of peritoneal dialysis, it's much less common than it used to be because of improved technology and self-care techniques that are taught during initial training.

If you're receiving peritoneal dialysis, you can lower your risk of peritonitis by following these tips:

• Thoroughly wash your hands, including the areas between your fingers and under your fingernails, before touching the catheter.
• Wear a mouth/nose mask during exchanges.
• Observe the proper sterile exchange technique.
• Apply an antibiotic cream to the catheter exit site every day.

Immediately report any possible contamination of your dialysis fluid or catheter to your peritoneal dialysis nurse. In many cases, a single dose of antibiotics can prevent a contamination from turning into an infection.

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